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Updated: May 13, 2026

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Intentional left subclavian artery coverage without revascularization during TEVAR.

A Greiner¹, J Kalder, H Jalaie

¹European Vascular Center Aachen-Maastricht, Department of Vascular Surgery, University Hospital RWTH Aachen, Aachen, Germany. agreiner@ukaachen.de

The Journal of Cardiovascular Surgery

|February 28, 2013

Summary

Thoracic endovascular aortic repair (TEVAR) can cover the left subclavian artery (LSA), risking stroke. Current evidence on LSA revascularization is insufficient, leaving patient risk assessment uncertain.

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Area of Science:

Vascular Surgery
Interventional Cardiology
Neurology

Background:

Thoracic endovascular aortic repair (TEVAR) is increasingly used for thoracic aortic pathologies, offering perioperative benefits over open repair.
A significant challenge in TEVAR is the frequent coverage of the left subclavian artery (LSA) origin for adequate stent-graft sealing.
LSA coverage is associated with potential neurological complications like stroke and paraplegia, but reliable risk assessment is lacking.

Purpose of the Study:

To review the current evidence regarding the necessity and outcomes of left subclavian artery (LSA) revascularization during thoracic endovascular aortic repair (TEVAR).
To discuss the uncertainties in assessing individual patient risk for neurological complications following LSA coverage.
To highlight the ongoing debate and clinical dilemma surrounding prophylactic LSA revascularization in TEVAR.

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Last Updated: May 13, 2026

Computed Tomography (CT) Guided Implantation of a Totally Implantable Venous Access Port (TIVAP) through Subclavian Vein

Computed Tomography (CT) Guided Implantation of a Totally Implantable Venous Access Port (TIVAP) through Subclavian Vein

Published on: January 13, 2026

Main Methods:

Literature review and critical analysis of existing studies on TEVAR and LSA management.
Discussion of the current understanding of LSA coverage implications and revascularization strategies.
Synthesis of evidence to address the controversy surrounding intentional LSA coverage versus prophylactic revascularization.

Main Results:

Evidence quality regarding the necessity of LSA revascularization is low, with conflicting outcomes reported.
No reliable methods exist to accurately predict the individual risk of stroke or paraplegia after LSA coverage.
Intentional LSA coverage is common, but the decision for revascularization remains based on assumption rather than definitive data.

Conclusions:

The optimal management of LSA coverage during TEVAR remains unclear due to insufficient high-quality evidence.
The risk of devastating neurological complications necessitates a thorough discussion of prophylactic LSA revascularization.
Further research is crucial to establish clear guidelines for LSA management in TEVAR procedures.